Regrets...

I have been trying to calculate out the cost of being a doctor in Canada.
In Australia, it was fairly straightforward; the cost of medical school, plus living expenses, for 4.5 years. You apply for jobs, get interviewed, and get hired by a hospital.  You get paid a salary for your work at the hospital. It is less than a full "Staff" salary, because they assume you will be taking time for learning and education, but you make a living wage for the hours you work.

In Canada, you have to pay to apply for jobs. It costs about 200 bucks to THINK about applying, then, for every school you send a letter to, they charge you another 50-80 dollars. If you get interviews, add transportation costs and accommodation to the bill.

Once interviews are done, you rank the universities from one to ten, or six, or x. Then you wait.

On a specific day, you log in to your account and see what school has picked you. You only get one offer. If you are offered the position, you are legally required to take it. Boom. Five years of your life are set in stone, all through luck of the draw. I did this, and got sent to U of T for my family med program. Yes, it was my first choice, but I don't know that I'd make it twice.

So, back to my interviews. I now know that I want further training in Emergency Medicine so I saddled up for the CaRM's rodeo once again; application fee, individual university application fees, rental car, flights, hotels in Kingston, Ottawa & St Johns. I figure, all in, I'll have spent about $2000 by the time this process is up.

People keep telling me the cost is an investment in my future. And sure, if I get the job, it will all have been worth it. But the ER match is not guaranteed. They interview 40 candidates for 4 places in Ottawa. The odds aren't much better anywhere else.

An investment is where you put your money into a holding pattern, hoping that it will increase in value over time. 1/10 odds sound more like gambling.

Frankly, there are a lot of other things I could do with $2000. Things that don't require me to explain my best qualities to a panel of bored and cranky interviewers.

O Australia. How I miss you.

boredom

The nights are dark and still and cold now. In the morning, frost clings to the grass. I leave a trail of footprints on the nature strip and track dew into the clinic. Nature provides a symphony of sensory delights in gorgeous Kincardine.

I am so bored.

The surgeon has moved out of the Locum House, taking away the element of chaos. Say what you will about ego & man... every house needs a force of nature who comes home and says "We're going to play volleyball now".

I am getting lots of sleep. Exercising for at least an hour a day. Cooking balanced and elaborate meals. Painting my toenails. Finishing my assignments early. Preparing for my exams in May.

I keep volunteering to work more in ER, but my boss feels I should work in clinic with him. Clinic is a good learning experience. Clinic is orderly and structured. Clinic is deadly boring...

When you apply for your Rural Rotation, you can choose to do 2 months back to back or seperate them out. They suggest that you double up, "to get the true rural live-work experience". I have been here for 5.3 weeks. I have such bad cabin fever that I considered getting drunk tonight as a means to kill time.

I am living the true rural experience. 

What Happens at Work...

Yesterday I had an afternoon off. Between 12 and 6pm, I wandered the sunny streets of Kincardine, napped, ate cookies and wrote thank you notes.

Between the hours of 12 and 6 pm, two people came in to the Emergency Department and died.

A woman had come in to hospital with shortness of breath. It had been going on for several days, but was now getting worse to the point that she and her husband were worried. They dropped the dog off at the groomers and brought her to ER. She walked in gasping, and wheezing. They put her on a stretched, she arrested and she died. It was completely unexpected.

Her husband was obviously terribly distressed. He went to pick up the dog before telling his family about the sudden tragedy that had struck them. He was in the parking lot outside the dog groomers when he collapsed. The ambulance was there in 5 minutes, but by the time he arrived in ER, he was dead too.

Husband and wife from healthy and well to stone cold in 5 hours.

I arrived at 6 to meet a shaken supervising Doctor. He had offered to cover the half-shift from 1-6 so his colleague could attend a meeting. He was not expecting a day like this.

My night, after 6pm, was uneventful with respect to the patients. I, on the other hand, blacked out while fighting with a drug addict. I woke up in the resuscitation room with my boss listening to my chest. "Did you know you have a heart murmur?" he asked. "Do you think you could be pregnant?".

The nurses brought me orange juice and petted me and called me sweetie for the rest of the night. I got up, saw patients until 1am, then went home to sleep. There was no reason for me to faint (eg: not prego). I was not expecting a night like that.

On again Friday. I don't know what to hope for, but whatever happens, it will be interesting.

I know this place

I am on day 3 of my rural rotation and I have a strong sense of deja vu. My intern year included 3 months in Warrnambool; a small town on the southern coast of Australia. Kincardine is a small town on Lake Huron, which might as well be the ocean. Wide streets, gorgeous blue skies and lots of leafy trees. The only difference is the accent.

The rural placement is a bizarre situation. Designed by medical schools to encourage rural practice, they are often incredibly luxurious. Right now I'm sitting in a 5 bedroom architectural gem, where sunlight streams from every window and Adirondack chairs overlook the hummingbird garden. I walk to work, have my scrubs provided, nurses prep and review each patient before I see them and I'm out on time every day. Luxury. Right?

Well. Tonight I'm running the ER overnight. Most of the time this means coughs, cuts and chest pain. Sometimes it means managing a stabbing from the local pub. Sometimes they have a 3 vehicle pileup on the freeway and send the mangled bits your way. The other Docs can be called in, but you're the first port of call.

Great luxury? Great responsibility. To paraphrase Alfred.


In the 'Bool, I coped by coming home every day and watching Friday Night Lights. Today, as I try to sleep under a blanket of anxiety, I attempted The Newsroom.

I'm gonna need another distraction.

Blip!

Anaesthetics has previously been described as 98% boredom, 2% disaster.
This is apt.

However, this is also a perfect description for weekend call on Internal Medicine. I spent my morning scrolling through bloodwork results, checking vital signs, writing succinct notes to demonstrate due diligence and thinking about afternoon tea. It was dry, mind-numbing work, but I powered through and got it done.

Finally, I got my chai latte & rice-krispie square (delightful!) and sat down for 15 minutes of well deserved rest.

My pager went off.

"Patient desaturated to 75%, not responsive, please come ASAP"

The next 2.5 hours are lost in a blur of suctioning, blood gases, sternal rubs, compressions and ultimately, begging the ICU doctor to take my patient to a safe place. That is, a place he can be intubated.

I stumbled back into the Doctor's lounge and was surprised to find my latte was cold. I was drenched in sweat. My hands are still shaking. I have 22 unanswered pages.

Internal Medicine: 90% paperwork, 10% shit hitting fan.

0% afternoon tea.

Joy!*

I have been dreading my family medicine clinic all week; I haven't seen my patients in a MONTH and I was expecting an afternoon of drear, gloom and complaints about life.

I got giggly babies, fetal heart rates, happy chat with my mentally challenged patient (she has a new boyfriend who is really really nice to her and takes her on bike rides) and a new installment of the "My Weird Penis" show. (This week's contestant had surgery to have small plastic lumps inserted under his penile skin "to give ladies pleasure". I don't know if he meant my irrepressible mirth, but it certainly worked.)

I have but 2.5 weeks of internal medicine to go. Yes, it's a hellish slog that sucks joy from my life and colour from my cheeks, but it has it's benefits. Specifically, it forces me to appreciate my career choice.

So, yes! Bring me your tired. Your back pain. Your poopy babies and your sore knees. Your weird rashes and your dribbly genitals. Bring it all, bring it on! I love my job!

*It should be noted that I consumed an entire jar of leftover frosting before composing this post. FYI.

Truth!

My dentist thinks I'm awesome. In fact, he thinks my life and my choices are so awesome that he would like me to sit down with his 13 year old daughter and give her life advice. If I hadn't had 17 steel pointy things embedded in my gums, I might have laughed at this.

I've been home (on vacation) for 3 days. I wake up reaching for my pager. Friends ask me how work is going and I tell them I'm dead inside. My "hilarious anecdotes" of time on the wards are met with silence. All I want is to sleep, but I am too anxious to relax. Would wish this life on a 13 year old?

I will admit, there are aspects of the job that I like. I like working with people. I like looking for clues about what's wrong, then testing my hypothesis with treatment. I like when I get it right. I like figuring out where I'm going wrong. I like the adrenaline of Code Blues. I like the warm fuzzies of family meetings. I like the camaraderie of Team Medicine. BUT I would like it to happen in manageable, 12 hour stretches, with ample rest and recuperation in between.

Anyways, my life advice for 13 year old girls (me) would be:
- If you can do it for 3 hours in a row without noticing time pass, it's a passion.
- If it makes you feel stronger, smarter and more engaged with the world around you, keep doing it.
- If it gets in the way of your hobbies and you feel stressed, stop doing it.
- Don't worry too much about finding boys/girls/romance.The bad ones are passive and hard work and will exhaust you. The good ones will find you and make your life more fun.
- Don't let your parents tell you what you like. Don't let your friends tell you what you like. You are the only one who has to live with your choices, and no matter what you choose, you'll end up annoying someone. Don't let it be you.

Presumably she (I) would roll her eyes at me. Then I would take her out for a blizzard, buy her clothes her parents won't like and tell her to call me anytime.